Pituitary surgery in elderly patients: a safe and effective procedure

Area of Science:

• Neurosurgery
• Endocrinology
• Geriatric Medicine

Background:

• Pituitary adenoma (PA) incidence rises with age.
• Transsphenoidal surgery (TSS) in elderly patients traditionally carries perceived higher risks.
• Evaluating outcomes in elderly patients undergoing TSS is crucial for clinical decision-making.

Purpose of the Study:

• To compare surgical results, disease evolution, and postoperative complications in elderly versus younger patients undergoing TSS for pituitary adenoma.
• To assess the safety and efficacy of TSS in an aging population.

Main Methods:

• Retrospective review of 125 patients undergoing TSS between 2011 and 2018.
• Patients were stratified into two cohorts: elderly (≥65 years) and non-elderly (<65 years).
• Comparison of clinical characteristics and outcomes at diagnosis, pre-surgery, and over a mean 5.9-year follow-up period.

Main Results:

• Elderly patients more frequently presented with non-functioning pituitary adenomas (NFPA), macroadenomas, and extrasellar extension.
• Despite higher rates of preoperative hypopituitarism and compressive symptoms in the elderly, overall surgical and endocrinological outcomes were similar between groups.
• Long-term, elderly patients showed more postoperative hypopituitarism but fewer residual tumors and higher remission rates post-TSS.

Conclusions:

• Transsphenoidal surgery (TSS) demonstrates safety and efficacy in elderly patients with pituitary adenoma (PA).
• Age alone should not preclude patients from undergoing TSS, especially when managed by an experienced pituitary team.
• Successful outcomes are achievable in older adults, challenging the notion of age as a strict exclusion criterion.